Transient cortical blindness following coronary angiography: a case report

Transient cortical blindness is an extremely rare and reversible neurological complication following angiographic procedures and is thought to be related to transient dysfunction of the occipital cortex. We report a 62-year-old woman with hypertension who underwent coronary angiography using 40 mL of the iso-osmolar contrast medium iodixanol. No significant coronary stenosis was identified. Approximately 10 min after contrast medium injection, she developed rapidly progressive bilateral visual loss, which progressed to complete blindness, accompanied by dizziness but without other neurological deficits. She remained alert, with preserved pupillary light reflexes and a normal ophthalmologic examination. Emergent cranial CT and MRI, performed approximately 25 min after contrast injection, showed no evidence of acute infarction or hemorrhage. Based on the close temporal association with contrast exposure and the exclusion of other causes, contrast-induced transient cortical blindness was considered. With supportive treatment, her vision gradually recovered and returned nearly to normal within one week. No abnormalities were observed at the 3-month follow-up.

Even iso-osmolar contrast agents such as iodixanol may induce transient cortical blindness. Further studies are needed to clarify the underlying mechanisms.